Occurrence Of Hiatal Hernia Research Articles

The Association of the Presence of Esophageal and Colonic Diverticula with Hiatal Hernia: A Cross-sectional Study.

This study investigates the association between the presence of diverticula in the colon and esophagus and the occurrence of hiatal hernia, seeking to understand potential shared pathophysiological underpinnings and risk factors. A cross-sectional study was conducted at a tertiary care center, including patients aged ≥18 years who underwent both gastroscopy and colonoscopy over 2 years. Exclusion criteria were prior gastrectomy or colectomy, incomplete medical records, and non-consent. The presence of hiatal hernia, colonic, and esophageal diverticulosis was identified via endoscopy. Logistic regression analysis assessed the associations, adjusting for age and sex. Among 3563 participants, males showed a higher prevalence of hiatal hernias compared to females (76.1% vs. 23.9%, P < 0.001). Hiatal hernia patients had a mean age of 51.28 years, slightly higher than those without (49.62 years, P = 0.034). A significant association was found between hiatal hernias and colonic diverticulosis (11.8% vs. 1.8%, P < 0.001), as well as between hiatal hernias and esophageal diverticulosis (2.4% vs. 0.3%, P < 0.001). Adjusted logistic regression revealed a 5-7 times higher likelihood of colonic diverticulosis in patients with hiatal hernias (odds ratio = 5.64, 95% confidence interval: 3.60-8.83; P < 0.001). The study demonstrates a notable association between hiatal hernias and the presence of both colonic and esophageal diverticula, suggesting common pathophysiological processes. These findings highlight the need for further research into shared risk factors and mechanisms underlying these conditions, potentially guiding improved management strategies for affected patients.

P54 INCIDENCE AND OUTCOME OF HIATAL HERNIA AFTER OESOPHAGECTOMY: COMPARISON OF TRADITIONAL OPEN AND MINIMALLY INVASIVE APPROACH

Abstract Aim The primary aim of this retrospective study is to evaluate the incidence of symptomatic and asymptomatic hiatal hernia (HH) in patients who have undergone intended curative open or minimally invasive oesophagectomy (MIO) for cancer of the oesophagus in a high-volume surgical centre. The secondary aim is to describe the treatment and outcome after HH treatment. Background &amp; Methods MIO for the treatment of oesophageal cancer has emerged as an alternative to traditional open oesophagectomy without compromising disease free or overall survival1. HH of abdominal viscera other than the gastric conduit is an infrequent but potentially life-threatening complication following oesophagectomy. HH may present with grievous complications, such as severe respiratory failure, intestinal ischemia with perforation, bowel obstruction, and strangulation leading to emergency surgery2,3. Surgical repair of these HHs is associated with a high morbidity rate and in the emergent setting even a high mortality4. In meta-analysis, the pooled incidence of symptomatic HH after MIO was 4.5 %, compared to a pooled incidence of 1.0 % after open oesophagectomy5. However, studies on the subject, often do not describe whether patients are asymptomatic or simply have not been examined for the existence of HH. The actual HH incidence may therefore be underestimated and may be more sufficiently reported when including patient material with comprehensive follow-up. This retrospective cohort study includes all patients (n≈455) who have undergone curative intended resection for malignant disease in the oesophagus at The Department of Surgery, Odense University Hospital, from 1th January 2012 – 31th December 2018. Patient demography, perioperative data including surgical approach and follow-up, including occurrence and treatment of hiatal hernia, mortality and recurrence of malignant disease will be extracted from complete electronic patient records. Follow-up ranges from 6-84 months. Primary outcome is occurrence of hiatal hernia after oesophagectomy determined by CT-scan or during surgery. Results As of abstract deadline for ESDE 2019, we have only just received permission for the study from The Danish Patient Safety Authority and can unfortunately not present our results yet. However, we expect that results are ready for presentation at ESDE 2019 and hope for your understanding.

Hiatal Hernia After Esophagectomy for Cancer

Hiatal hernia (HH) after esophagectomy is becoming more relevant due to improvements in survival. This study evaluated and compared the occurrence and clinical course of HH after open and minimally invasive esophagectomy (MIE). The prospectively recorded characteristics of patients treated with esophagectomy for cancer at 2 tertiary referral centers in the United Kingdom and the Netherlands between 2000 and 2014 were reviewed. Computed tomography reports were reviewed to identify HH. Of 657 patients, MIE was performed in 432 patients (66%) and open esophagectomy in 225 (34%). A computed tomography scan was performed in 488 patients (74%). HH was diagnosed in 45 patients after a median of 20 months (range, 0 to 101 months). The development of HH after MIE was comparable to the open approach (8% vs 5%, p= 0.267). At the time of diagnosis, 14 patients presented as a surgical emergency. Of the remaining 31 patients, 17 were symptomatic and 14 were asymptomatic. An elective operation was performed in 10 symptomatic patients, and all others were treated conservatively. During conservative treatment, 2 patients presented as a surgical emergency. An emergency operation resulted in a prolonged intensive care unit stay compared with an elective procedure (3 vs 0 days, p<0.001). In-hospital deaths were solely seen after emergency operations (19%). HH is a significant long-term complication after esophagectomy, occurring in a substantial proportion of the patients. The occurrence of HH after MIE and open esophagectomy is comparable. Emergency operation is associated with dismal outcomes and should be avoided.

Thoracic Deformity and Hiatal Hernia (Intrathoracic Stomach) in the Elderly

The incidence of hiatal hernia (HH) increases with age. Vertebral fracture, kyphosis, and pulmonary emphysema are suspected as possible causes. We aimed to analyze the relationship between thoracic deformities and HH in the elderly, using a deformity index. The study participants comprised 427 inpatients at a long-term-care hospital for the elderly in Japan. The Haller index (HI) was calculated on the transverse thoracic computerized tomography images according to the following formula: transverse diameter of the thorax/anterior-posterior diameter of the thorax. HH was diagnosed when an intrathoracic stomach was seen on the computed tomography images. The average HI calculated for all cases and for women--but not for men--decreased with increasing age. HH was diagnosed in 21 patients (4.9%). The incidence of HH in women was higher than in men (male vs. female = 2.0% vs. 7.4%). The mean value of HI in the HH patients (1.651 ± 0.251) was significantly lower than that in non-HH patients (2.345 ± 0.460). Enlargement of the anterior-posterior diameter of the thorax occurs in the elderly and is associated with the occurrence of HH.